Healthcare Provider Details

I. General information

NPI: 1992360234
Provider Name (Legal Business Name): RIE HONDA MIZUKI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11879 DEL AMO BLVD
CERRITOS CA
90703-7605
US

IV. Provider business mailing address

10181 PIMLICO DR
CYPRESS CA
90630-4144
US

V. Phone/Fax

Practice location:
  • Phone: 562-537-8731
  • Fax:
Mailing address:
  • Phone: 562-537-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: